5/14/2026

speaker
Operator
Conference Operator

Thank you for standing by, and welcome to ELUSHA's first quarter 2026 earnings conference call. Currently, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 1-1 on your telephone. To remove yourself from the queue, you may press star 1-1 again. I would now like to hand the call over to Bernadine Cherniak. Please go ahead.

speaker
Bernadine Cherniak
Vice President, Investor Relations

Thank you, Operator, and thank you all for participating in today's call. Earlier today, Alusha released financial results for the first quarter and in March 31st, 2026. A copy of the press release is available on the company's website. Before we begin, I would like to remind you that management will make statements during this call that include forward-looking statements within the meaning of the federal securities laws which are pursuant to the safe harbor provision of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that do not relate to matters of historical facts or relate to expectations or predictions of future events, results, or performance are forward-looking statements. All forward-looking statements, including without limitation, those relating to our operating trends and future financial performance are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For lists and descriptions of the risks and uncertainties associated with our business, please refer to the risk factors section of our public filings with the SEC, including Alicia's annual report on Form 10-K for the year ended December 31st, 2025, and our subsequent periodic reports on Form 10-Q and 10-K, accessible on the SEC's website at www.sec.gov. Such factors may be updated from time to time in Alusha's other filings with the SEC. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, May 14, 2026. Alusha disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements because of new information future events, or otherwise. Also during this presentation, we refer to gross margin, excluding intangible assets, amortization, which is a non-GAAP financial measure. A reconciliation of this non-GAAP financial measure to the most directly comparable GAAP financial measure is available on the company's financial results released for the first quarter and in March 31, 2026. This is accessible on the SEC's website and posted on the investors' page of the Alusha website at www.alusha.com. And with that, I will turn over the call to Alusha's CEO, Randy Mills.

speaker
Randy Mills
Chief Executive Officer

Thank you, Bernadine. And thank you, everyone, for joining us today. The first quarter of 2026 was an important quarter for Alusha. We continued to sharpen our strategic focus. We advanced our NXT 41 regulatory program, We brought our automated manufacturing platform online and we further strengthened our confidence in the commercial opportunity ahead of us in breast reconstruction. Here's how we'll spend our time today. I'll walk you through the headlines of the quarter and where we're headed. Matt will take you through the financials and close with a few thoughts on what's ahead. Then we'll open the line up for questions. Today, Aleutia is increasingly becoming a pure play drug eluding bio matrix company focused on one of the largest and most underserved opportunities in reconstructive surgery. Four things I would like to highlight from the quarter. First, our FDA review of NXT 41 is progressing through productive interactions with the agency and the dialogue has increased our confidence in the planned NXT 41X submission. We continue to anticipate NXT 41 clearance in the fourth quarter of 2026 and NXT 41X clearance in the first half of 2027. Second, we brought our automated manufacturing platform online this quarter. That platform supports a target gross margin in excess of 80% at scale, enabling a differentiated value proposition at competitive pricing. Third, direct surgeon engagement by our commercial team is confirming what we have believed all along, a $1.5 billion U.S. market. Postoperative infection rates of 15% to 20% and no meaningful innovation in standard of care. In fourth, we ended the quarter with a strong balance sheet, $36.5 million in cash and escrow, and we are actively engaged in two strategic processes, the simpliderm divestiture we previously announced and a newly disclosed inbound acquisition interest in our cardiovascular product line. It is increasingly clear that within the $1.5 billion breast surgery market, NXT 41X has the potential to be a blockbuster and to meaningfully improve outcomes for women with breast cancer. For anyone new to the Aleutia story, here is the short version of what we do. Our approach is simple but differentiated. We combine a proven biologic matrix platform with sustained local antibiotic delivery designed to prevent bacterial colonization and the cascade of complications like infection that can follow. Importantly, we have done this before. Our first generation drug-eluting product, Eliupro, was the first FDA-cleared antibiotic-eluting bioenvelope. We developed it. We cleared it. We commercialized it. And last October, we sold that business to Boston Scientific for $88 million. That prior success gives us confidence not only in the technology itself, but also in our ability to develop, make, and commercialize differentiated drug-eluting products. NXT 41X takes that same validated platform into a much larger market with a much larger unmet medical need. We believe the opportunity in front of us is transformational for three reasons. One, it's a big market, $1.5 billion in the U.S. alone. Two, it's a big problem. 15 to 20% of patients develop post-operative infection after a mastectomy. And if anything, that number is conservative. And three, we already have a proven solution. The $88 million that Boston Scientific paid for our first-generation product tells you that it works. Let me put the market into concrete numbers. Approximately 168,000 breast reconstruction procedures last year were performed in the United States. Biologic mesh is utilized in more than 85% of those implant-based reconstructions. Biologics account for roughly 65% of the total procedural spend And human biologic mesh today sells for somewhere between 7500 and 9500 per breast. Put that all together and you have a billion and a half dollar US market opportunity. This is not a market we have to create. It already exists. Biologic matrices are already deeply embedded into the standard of care. Surgeons use them in the vast majority of these procedures. Our job is simpler than building a new category. We just have to give them a better version of what they're already using. In breast reconstruction, the unmet need for this is severe. One in three women suffer a serious complication after reconstruction. 15 to 20% develop a post-operative infection, up to 21% experience implant loss, and the average hospital cost of a single infection ends up being more than $48,000. But remember why this woman is in the operating room in the first place. She was diagnosed with cancer. Her number one goal is to beat that cancer, and when infection takes hold, Chemotherapy stops, radiation stops, everything stops until the infection is resolved. This is not a minor complication. This is a cancer treatment derailing event, and the standard of care today does not solve it. NXT41X is not a passive support mechanism. It is an active partner in recovery. It is easy to use. It fits the surgical workflow the surgeon already knows. It's cost neutral to the hospital. It replaces legacy products that they're already buying. And it delivers powerful, sustained, uniform antibiotic coverage right at the surgical site where systemic antibiotics struggle to reach. Unlike legacy biologic matrix that have little functional differentiation, our goal is to deliver differentiated functionality at a competitive economic profile. We believe that matters. With that backdrop, let me walk you through the work we did this quarter to advance the program. Let me first start with the FDA review. We continue to have productive interactions with the FDA regarding the NXT-41 submission. As a reminder, NXT-41 is the base biologic matrix and it serves as the foundation for NXT-41X drug-eluting version that will follow. While we're not gonna comment on every detail of the review process, what I can say is that our dialogue with FDA has increased our confidence in the plan NXT 41X submission strategy. The discussions have helped clarify what FDA views as an important from a submission standpoint. We continue to anticipate NXT 41 clearance in the first quarter of 2026 and expect 41, NXT 41X clearance in the first half of 2027. The point I want you to take from this slide is our confidence has increased. Let me shift to manufacturing. One of the most important accomplishments this quarter was bringing our automated manufacturing platform online. We have now installed and operationalized the core automated production equipment intended to support NXT 41X manufacturing at scale. This is strategically important for several reasons. First, the robotic coding system enables precise and reproducible application of the drug eluding layer onto the biologic matrix. Second, the integrated in-house approach is designed to support scalability, efficiency, and quality control. And third, we believe this process creates a meaningful competitive advantage. The integrated process supports a targeted gross margin of above 80% at scale. And an 80% plus gross margin gives us real pricing room against incoming products that sell for between $7,500 to over $9,500 per breast. while still delivering best-in-class margins. Said differently, NXT 41X is designed to compete both on outcomes and cost. That is a hard combination for an incumbent to respond to. Now let me turn to commercialization, which I'm particularly excited about. Our commercial readiness work continues to increase our confidence in the market opportunity. Since joining Aleutia, Our chief commercial officer, Pete Ligotti, has spent a substantial amount of time in the field speaking directly with surgeons and hospital stakeholders, and the feedback has been remarkably consistent. The clinical need is real, and it is significant. Surgeons describe postoperative infection and downstream complications as one of the most frustrating challenges they face in breast reconstructions. Second, there remains a clear lack of meaningful innovation anywhere within this category. And third, the commercial opportunity appears to be highly concentrated. Look at this funnel. As we discussed, the U.S. breast reconstruction market is a billion and a half dollars, and there are about 168,000 procedures performed last year. About 1,800 hospitals U.S. hospitals perform reconstruction, but only 585 of those hospitals account for three-quarters of the entire market, and the top 50 centers alone represent over $300 million in spend. Here's the insight. This is a billion-dollar-plus U.S. market, but the real volume is concentrated at a few hundred hospitals This is not a market that requires thousands of accounts or a massive sales infrastructure to establish meaningful penetration. We believe targeted engagement with high volume centers can create substantial leverage, and that is exactly the team Pete is putting together. Before Matt walks you through the financials, let me briefly address our strategic process. As we have previously discussed, We continue to evaluate opportunities to further focus the company around NXT 41X and its platform. With Simpliderm, interest is strong and the process is going well. Simpliderm is a high-quality business, $2.1 million in revenue in this quarter at a 57% gross margin. We have strong reimbursement coverage with approximately 100 million covered lives across UnitedHealthcare, Anthem, and nine regional plans, and it has a differentiated patent-protected manufacturing process. But separately, we have received inbound acquisition interest in our related cardiovascular product line. For context, that business did a million dollars in revenue this quarter at an 85% gross margin, and that's up from $300,000 just a year ago. These are strong products with differentiated clinical profiles and attractive gross margins. However, as we evaluate the company strategically, our priority is ensuring that capital, resources, and management attention are aligned with the largest long-term opportunity for value creation, which is NXT 41X. So we are going to provide further updates on both processes as appropriate. Now with that, I'd like to turn the call over to Matt.

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